| Republican-led states that have resisted expanding Medicaid for more than a decade are showing new openness to the idea, Axios Raleigh's Lucille Sherman and Axios Atlanta's Emma Hurt report. Driving the news: In the decade-plus since the landmark Affordable Care Act was enacted, 12 states with GOP-led legislatures still have not expanded Medicaid coverage to people living below 138% of the poverty line (or nearly $19,000 annually for one person in 2022). - But there's evidence that the political winds are changing in holdout states like North Carolina, Georgia, Wyoming, Alabama and Texas, as leaders court rural voters, assess new financial incentives and confront the bipartisan popularity of extending health care coverage.
Why it matters: Medicaid expansion, a key component of the Affordable Care Act, means increasing access to federal health insurance coverage for low-income residents in exchange for a 10% state match of the federal spending. - Experts say it expands access to care, lowers uninsured rates and improves health outcomes for low-income populations.
- More than 2 million Americans would gain coverage if the 12 states expand Medicaid, according to a 2021 estimate from the Kaiser Family Foundation.
What's happening: In Georgia, conversations about a path forward have been taking place behind the scenes in both parties. This follows the stunning support of full expansion legislation by North Carolina's top Republican this spring, first reported by Axios Raleigh. - "If there is a person that has spoken out more against Medicaid expansion than I have, I'd like to meet that person," Republican Senate leader Phil Berger said at a May press conference after reversing his stance. "This is the right thing for us to do."
- Brian Robinson, former spokesman for the first Georgia governor to reject Medicaid expansion, argued in June it's time to make the change. Politically, it would "steal an issue" from Democrats, he told Axios Atlanta.
In Alabama, former Gov. Robert Bentler — who had refused to expand Medicaid himself — is now urging his fellow Republicans to pass it for the benefit of rural parts of the state. In Wyoming, mixedbipartisan legislative movement on expansion this year has given advocates fresh hope. In Texas, the state with the highest percentage of uninsured residents per capita, some Republicans have co-sponsored Medicaid expansion bills. - That indicates "cracks" in Republican opposition, Luis Figueroa, legislative and policy director at progressive think tank Every Texan, told Axios Austin.
In Tennessee, the Republican lieutenant governor suggested possible openness to the policy last year, though there's been no meaningful legislative movement. The intrigue: Democrats in these states, including gubernatorial candidates like Georgia's Stacey Abrams and Texas' Beto O'Rourke, are campaigning heavily on Medicaid expansion — banking on polling showing the policy to be widely popular among the public. Keep reading. | 
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